Individual
DR. DAVID G MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 000-0000
(574) 000-0000
Mailing address
10466 WOODCHUCK CT, GRANGER, IN 46530-6029
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01037623A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084424
BLUECROSS BLUESHIELD
IN
05
—
100323890A
—
IN
01
—
110082367
RAIL ROAD MEDICARE
IN
01
—
2004184004
CIGNA
IN
01
—
4229217
AETNA
IN
Enumeration date
06/10/2005
Last updated
05/19/2016
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